Monitoring the implementation of

the TB Action Plan for the WHO

European Region, 2016–2020
EU/EEA situation in 2016
ECDC Tuberculosis Programme
European Centre for Disease Prevention and Control

Stockholm, 24 March 2018

1
Three areas of intervention with 26
indicators to assess countries’
performance in tackling TB*
1. Integrated patient-centred care and prevention

2. Bold policies and supportive system

3. Intensified research and innovation

* 19 indicators out of 26 are analysed for 2016 2

1. Integrated patient-centred
care and prevention

3
 1.A. Systematic screening of contacts and
high-risk groups
Indicator 1.A.1 Percentage of coverage for population at risk with systematic screening for active TB
and latent tuberculosis infection (LTBI) (only TB contacts evaluated), 2016

Target: 80%
Status 2016: Five countries reported data, four countries met the target

Target >80%
Slovakia

Lithuania

Bulgaria

Norway

Portugal

Total EU/EEA

0% 20% 40% 60% 80% 100%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 4
 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.1 Percentage of newly notified TB patients diagnosed using WHO-recommended rapid tests

Target: 40%
Status 2016: 25 countries reported data, nine met the target

100% Target = 40%

80%

60%

40%

20%

0%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 5
 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.2 First-line drug susceptibility testing (DST) coverage (%) among all
bacteriologically confirmed TB cases (G1)
Target: 100%
Status 2016: 30 countries reported data, seven met the target
Target = 100%
100%

80%

60%

40%

20%

0%
A e al d ia ly r y y ia ia i c d ia m ia g ia m d y s rk d n a e ia ta s ia in
/EE eec tug elan vak Ita ga man gar an ubl olan str giu ton our atv do nlan rwa ypr u ma elan ede oati anc uan al land ven Spa
r
EU G Por Ic Slo H un er Bul om Rep P Au Bel Es mb L ing Fi No C en Ir Sw Cr Fr ith M er lo
S
ta
l G R h xe d
K D L eth
o c L u e N
T e it
Cz Un

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 6
 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.3: Percentage of rifampicin-resistant and multidrug-resistant (RR/MDR) TB case detection rate (%)

Target: 85%
Status 2016: 24 countries reported data, nine met the target

Target = 85%
100%

80%

60%

40%

20%

0%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 7
 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.4 TB notification rate per 100 000 population (E1)
Target: below 24.6
Status 2016: 30 countries reported data, 27 met the target
70
Target = 24.6
Notification rate per 100 000 population

60

50

40

30

20

10

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 8
 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.5: percentage of TB case detection rate (%)

Target: 84%
Status 2016: 30 countries reported data, 26 met the target

Target = 84%
100%

80%

60%

40%

20%

0%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 9
 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.6 Percentage of RR/MDR TB among new TB patients (E2)

Target: Decreasing percentage compared to baseline in 2014

Status 2016: 30 countries reported data, 14 met the target
20%

15%

10%

2016 situation Baseline 2014

5%

0%
l
E EA atia prus land alta urg enia land aria blic uga nce ium om land ark nds ece ania akia any tria den Italy land pain ary way tvia onia ania
/
EU C r
o Cy ce
I M bo lov Po ulg epu ort Fra elg ingd Fin enm erla Gre om lov erm Aus Swe Ire S ung or La st hu
N E it
l e m S B R P B K D et h R S G H L
ta
-5% x h d
To Lu ec i te N
Cz Un

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 10
 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.7 Percentage of RR/MDR TB among previously treated TB patients

Target: Decreasing percentage compared to baseline in 2014

Status 2016: 24 countries participated, 14 met the target

80%

60%

2016 situation Baseline 2014

40%

20%

0%
A a s rk d d rg ta y ia al d m ia m e ly i n y ia n r y i c i a ia d ds ia e ia ia
/EE oati ypru ma nlan elan ou al rwa ven tug olan do vak giu anc Ita Spa man an ede ga ubl gar str elan lan atv eec uan ton
g l Fr n l u L Gr th Es
l EU Cr C Den Fi Ic emb M No Slo Por P Kin Slo Be Ger Rom Sw Hu Rep Bu A Ir ther Li
ota L ux e d c h Ne
T it e
Un Cz

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 11
 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.1 Percentage of hospitalisation among new TB patients (E3)
Target: Decreasing percentage compared to baseline in 2014 (data for 2014 not available)
Status 2016: 18 countries reported data
Latvia
Czech Republic
Slovenia
Lithuania
Slovakia
Bulgaria
France
Romania
Finland
Estonia
Ireland
Norway
Sweden
Luxembourg
Netherlands
Portugal
Iceland
Cyprus
Total EU/EEA

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 12
 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.2 Percentage of detected RR/MDR TB enrolled in treatment

Target: 100%
Status 2016: 26 Member States reported data, 22 met the target
Target = 100%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 13
 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.3 Treatment success rate (G2)

Target: 85% for new and relapse cases

Status 2016: 24 Member States reported data, six met the target
100%
90%
Target = 85%
80%
70%
60%
50%
40%
30%
20%
10%
0%
EA atia land rk and us and any blic ry al tria ia m m ia ia via aria ania akia and
s n y d
/E o m
a l ypr l u g a
tug s a n do
g i u
ve n
ton
a t g v l e de rwa l an
n o e m n u u g l L l e
lE
U Cr Fi en P C Ir er Re
p
Hu Po
r A ith Kin Be Slo Es Bu R om Slo her Sw No Ic
a D G h L t
to
t
zec ite
d Ne
b C n
Su U 14
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.3: Treatment success rate
Target: 85% for new and relapse cases
Status 2016: 24 Member States reported data, six met the target

Proportion of treatment
success

< 60%

60 to 84.9%

≥ 85%

Not reporting

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 15
 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.4 TB treatment success rate among the RR/MDR TB cohort, 2016
Target: 75% for new and relapse RR/MDR TB cases
Status 2016: 20 Member States reported data, four met the target
Target = 75%
Hungary
Sweden
Netherlands
Norway
Latvia
Estonia
Austria
United Kingdom
Belgium
Portugal
Slovakia
Ireland
Denmark
Bulgaria
Czech Republic
Romania
Germany
Poland
Lithuania
Croatia
Total EU/EEA

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 16
 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.4: TB treatment success rate among the RR/MDR TB cohort, 2016
Target: 75% for new and relapse RR/MDR TB cases
Status 2016: 20 Member States reported data, four met the target

Proportion of treatment
success

< 40%

40 to 74.9%

≥ 75%

Not reporting

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 17
 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.5 TB mortality rate (ICD A15-19)*

Target: below 2.7 deaths for WHO European Region

Status 2016: calculated for 30 EU/EEA countries, 28 met the target
8

6
Rate per 100 000 population

Target = 2.7
2

0
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Un
Su

*WHO estimates for 2016

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 18
 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.1 Percentage of detected cases among estimated incident TB/HIV co-infected cases

Target: 100%
Status 2016: 16 Member States reported data, one met the target
Target = 100%
Slovenia
Estonia
Denmark
Romania
Lithuania
Netherlands
Spain
Latvia
Norway
Portugal
Czech Republic
Malta
Luxembourg
Belgium
Ireland
Hungary
Subtotal EU/EEA

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 19
 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.2 HIV testing coverage

Target: 100%
Status 2016: 20 Member States reported data, one met the target
Target=100%
Iceland
Estonia
Malta
Norway
Cyprus
Slovenia
Bulgaria
Latvia
Romania
Lithuania
Portugal
Netherlands
Spain
Belgium
Slovakia
Ireland
Czech Republic
Denmark
Luxembourg
Hungary
Subtotal EU/EEA

0% 20% 40% 60% 80% 100%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 20
 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.3 Percentage of HIV co-infection among all TB (new and relapse TB cases)

Target: Decrease compared to baseline in 2014

Status 2016: 20 Member States reported data, 10 met the target
Luxembourg
Malta
Portugal
Estonia
Latvia
Spain
Belgium
Denmark
Hungary
Norway
Netherlands
Lithuania Baseline 2014 2016 situation
Ireland
Romania
Czech Republic
Slovenia
Slovakia
Iceland
Cyprus
Bulgaria
Total EU/EEA

0% 20% 40% 60% 80%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 21
 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.4 Percentage of HIV/TB co-infected patients enrolled in antiretroviral therapy (ART)

Target: 100%
Status 2016: 8 Member States reported data, four met the target

Target = 100%
Slovenia

Romania
Norway

Malta

Estonia

Ireland

Netherlands

Latvia

Subtotal EU/EEA

0% 20% 40% 60% 80% 100%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 22
 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.5 LTBI treatment enrolment rate (%) among people living with HIV/AIDS (PLHIV)

Target: 30%
Status 2016: Data were not available for 2016

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 23
 1.E. Management of latent tuberculosis infection
and preventive treatment of persons at high risk,
and vaccination against tuberculosis
Indicator 1.E.1: Percentage contact investigation coverage

Target: 90%
Status 2016: 4 Member States reported data, four met the target

Target = 90%
Slovakia

Lithuania

Norway

Spain

Total EU/EEA

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 24
 1.E. Management of latent tuberculosis infection
and preventive treatment of persons at high risk,
and vaccination against tuberculosis
Indicator 1.E.2: Percentage of LTBI treatment coverage among childhood TB contacts aged under five years

Target: 90%
Status 2016: Three Member States reported data, one met the target

Target = 90%
Slovakia

Slovenia

Norway

Total EU/EEA

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 25
2. Bold policies and
supportive systems

26
 2.A. Political commitment with adequate resources,
including universal health coverage policy
Indicator 2.A.1 Number of Member States that have a regular TB control/elimination performance
publication every five years (E8)

Target: TB control/elimination performance publication published

Status 2016: Data were not available for 2016

2.B. Health systems strengthening in all functions, including well-

aligned financing mechanisms for tuberculosis and human resources

Indicator 2.B.1 Percentage of TB patients and their households that experience catastrophic financial
consequences due to TB (G8) (E9)

Target: Close to 0
Status 2016: Data were not available for 2016

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 27
 2.C. Regulatory frameworks for case-based
surveillance, strengthening vital registration, quality
and rational use of medicines, and pharmacovigilance
Indicator 2.C.1 Treatment coverage with new TB drugs (%)

Target: 20%
Status 2016: Data were not available for 2016

2.D. Community systems and civil society engagement

Indicator 2.D.1 Number of Member States with functioning multi-stakeholder coalitions advocating for TB
care and resources

Target: Not defined

Status 2016: Data were not available for 2016

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 28
 2.E. Social protection, poverty alleviation and
actions on other determinants of tuberculosis,
such as migration and prisons
Indicator 2.E.1: Percentage treatment success of new and relapse TB cases among prisoners

Target: 85%
Status 2016: 13 countries reported data, four met the target
Target = 85.0
Slovakia
Romania
Estonia
Bulgaria
Czech Republic
Latvia
United Kingdom
Lithuania
Belgium
Portugal
Netherlands
Hungary
Poland
Total EU/EEA

0 10 20 30 40 50 60 70 80 90 100
Percentage of treatment success

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 29
 2.E. Social protection, poverty alleviation and
actions on other determinants of tuberculosis,
such as migration and prisons
Indicator 2.E.1 Treatment success of new and relapse TB cases among prisoners
Target: 85%
Status 2016: 13 countries reported data, four met the target

Proportion of treatment
success

< 60%

60 to 84.9%

≥ 85%

Not reporting

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 30
3. Intensified research and
innovation

31
 3.A. Discovery, development and rapid uptake of
new tools, interventions and strategies
Indicator 3.A.1 European Tuberculosis Research Initiative established by mid-2016

Target: Established
Status 2016: Country-specific indicators are not defined for 2016

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data 32
Summary by activity related to areas of
intervention, EU/EEA, 2016

1. Integrated, patient-centred care and prevention

• Five activities with 20 indicators defined, nine targets met at EU/EEA
level, seven targets not met, and one target not defined.

2. Bold policies and supportive system

• Five activities with five indicators defined, for four targets data were not
available for EU/EEA countries, one target not met.

3. Intensified research and innovation

• One activity with one indicator defined and country level target not
defined.

33